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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EAs new bioprostheses become available and implantation techniques are refined, an increasing proportion of patients with valvular disease are avoiding open surgery and undergoing percutaneous procedures. This article describes the advances that are making this possible.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EPercutaneous Treatments for Valvular Disease\u003C\/h2\u003E\n\u003Cp id=\u0022p-2\u0022\u003EAs new bioprostheses become available and implantation techniques are refined, an increasing proportion of patients with valvular disease are avoiding open surgery and undergoing percutaneous procedures. Investigators in this emerging field described the advances that are making this possible.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EPercutaneous Aortic Valve Replacement\u003C\/h2\u003E\n\u003Cp id=\u0022p-3\u0022\u003ECarlos E. Ruiz, MD, Lenox Hill Hospital, New York, discussed the CoreValve (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), which uses a self-expanding nitinol cage bioprosthesis made of a porcine pericardial valve. He said most patients are now receiving the 18 French (F) model and not the 25 or 21 F devices on which most observations have been based. The current third-generation model has an over-the-wire design, an 18 F distal end, a 12 F shaft body, a flexible catheter, and dual-speed release handle. \u201cNow, we deploy with no cut-down, no anesthesia, no rapid pacing, and no cardiac support,\u201d Dr. Ruiz noted.\u003C\/p\u003E\n\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022CoreValve.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-266111827\u0022 data-figure-caption=\u0022CoreValve.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11002\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003ECoreValve.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-5\u0022\u003EIn 63 patients with advanced heart failure who received the CoreValve, post-PVAR logistic EuroScore was 25.4, including 23.4 in the high-risk group and 31.6 in the nonoperable group. Procedural success was 91%, and 86% of high-risk patients were discharged alive and well with marked hemodynamic and clinical improvement sustained for more than 24 months. Multicenter studies with an 18 F device are ongoing to confirm these results.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EE. Murat Tuzcu, MD, of the Cleveland Clinic, described his experience with the balloon-expandable Cribier-Edwards aortic bioprosthesis, which uses a balloon-expandable stainless steel device that is made of an equine pericardial valve and is delivered via an unsheathed catheter (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E). A total of 391 patients received this device between April 2002 and March 2007.\u003C\/p\u003E\n\u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cribier-Edwards Aortic Bioprosthesis.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-266111827\u0022 data-figure-caption=\u0022Cribier-Edwards Aortic Bioprosthesis.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/27\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11003\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ECribier-Edwards Aortic Bioprosthesis.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-8\u0022\u003EIn REVIVAL II (Randomization of Endovascular Implantation of Valves), the bioprosthesis was successfully deployed in 87% of patients. Failures were primarily due to access problems that have been improved with re-design. In-hospital mortality was 16.4% (0 to 158 days). The major 30-day complications were iliac artery rupture (9.2%), minor stroke (5.6%), and renal failure (5.5%).\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EThe PARTNER trial will further evaluate this bioprosthesis in 350 high-risk surgical and 250 high-risk inoperable patients.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EPercutaneous Pulmonary Valve Replacement\u003C\/h2\u003E\n\u003Cp id=\u0022p-10\u0022\u003ESince percutaneous pulmonary valve replacement was first reported in 2000 it has been shown to improve pulmonary regurgitation, NYHA functional class, exercise tolerance, and other parameters in 158 patients, said Sachin Khambadkone, MD, of Great Ormond Street Hospital, London. The 6-year survival rate is 96%, with freedom from reoperation observed in 83% of patients at a mean of 30 months and in 60% at 63 months.\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003E\u201cWe have had some procedural complications\u2014some of which were related to the learning curve\u2014but no deaths,\u201d Dr. Khambadkone said. \u201cNew designs have helped prevent device failures.\u201d\u003C\/p\u003E\n\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n\u003Ch2 class=\u0022\u0022\u003EMitral Valve Repair\u003C\/h2\u003E\n\u003Cp id=\u0022p-12\u0022\u003EClinical proof-of-concept of the percutaneous approach to treating functional mitral regurgitation (MR) via the coronary sinus has been safely demonstrated in humans, reported Steven L. Goldberg, MD, University of Washington Medical Center, Seattle. There is a close relationship between the coronary sinus\/great cardiac vein and the posterior annulus of the mitral valve. Several devices have been developed based on the coronary sinus approach by Ample Medical, Cardiac Dimensions, Edwards Lifesciences, Mitralign, and Viacor.\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003EThe EVOLUTION (Clinical Evaluation Of the Edwards Lifesciences Percutaneous Mitral Annuloplasty System for the treatment of Mitral Regurgitation) feasibility study of Edwards\u0027 MONARC Annuloplasty System showed that 50% of patients achieved a reduction in MR of \u22651 grade at 3 to 6 months. \u201cThis was proof that the coronary sinus approach can significantly reduce mitral regurgitation,\u201d Dr. Goldberg said.\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EDescribing the Carillon Mitral Contour System by Cardiac Dimensions, he noted its ability to recapture, which allows the clinician to relieve compromise to the coronary artery as well as deploy a second device. After improvements in design, technical success now exceeds 80%. As each of these systems is modified and patients are more carefully selected, success with the percutaneous approach is growing, he said.\u003C\/p\u003E\n\u003Cp id=\u0022p-15\u0022\u003EDescribing edge-to-edge mitral valve repair, Igor F. Palacios, MD, of Massachusetts General Hospital, Boston, reported that this approach reduces MR to \u22641 in most patients and results are durable up to 36 months. Acute procedural success is now at 90%. Edge-to-edge repair reduces procedure time, produces few complications, and preserves the options for surgery.\u003C\/p\u003E\n\u003Cp id=\u0022p-16\u0022\u003EIn the Phase I EVEREST I trial (Endovascular Valve Edge-to-Edge Repair Study), which evaluated the MitraClip in 55 patients, 76% were discharged with only mild to moderate regurgitation. After 1 year, 75% had avoided surgery and 80% who underwent echocardiography still had only mild-to-moderate regurgitation, or none at all, according to results presented at the American College of Cardiology by Ted Feldman, MD, Evanston Northwestern Healthcare, Evanston, Illinois. \u201cWe earlier established that we could reduce mitral regurgitation with the MitraClip, and now we\u0027ve established the durability of the results,\u201d Dr. Feldman said. EVEREST II is currently enrolling.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/1\/27.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmbe2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmbe2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}